Los objetivos fueron conocer la incidencia atmosférica de polen en Santander y su repercusión sobre la población MÉTODOS: Método volumétrico de Hirst; influencia de la meteorología en el periodo de mayo a julio de 1998 a 2002, mediante medidas de asociación lineal entre variables meteorológicas diarias y los recuentos de polen diarios de gramíneas; pruebas cutáneas; relación entre las ventas mensuales de antihistamínicos en la ciudad y los recuentos mensuales de polen de gramíneas; y la relación entre los recuentos diarios y semanales de polen y variables meteorológicas y de contaminación con las asistencias a urgencias por rinoconjuntivitis y por asma en niños. Encuesta sobre síntomas de asma de la IUATLD y un cuestionario sobre 11 factores del interior. RESULTADOS: La media anual de polen total fue 8.604, el polen de familia poaceae supuso el mayoritario (28 %). La temperatura máxima fue la única variable explicativa de los recuentos de polen en su periodo. El 100% de los pacientes estaban sensibilizados a poaceae. Se encontró relación mensual de los recuentos de poaceae con las ventas de antihistamínicos (rs= 0,7; p<0,01) y relación diaria y semanal de dichos recuentos con las asistencias por rinoconjuntivitis en niños y adultos. Las asistencias a urgencias por asma en niños (2.396) y adultos (1.665) fueron más frecuentes de septiembre a diciembre. Se encontró relación durante el periodo de mayo a julio de los recuentos semanales de poaceae y de temperatura con las asistencias a urgencias en niños. La prevalencia de síntomas de asma en adultos fue de 15% (9,8 - 20,2). Mayor frecuencia de síntomas de asma entre quienes tenían un animal en casa : 41% frente a 14%; OR: 4,2 (1,9 - 9,2) y quienes habían vivido en Santander sus primeros 10 años de vida: 22% frente a 11%; OR: 2,9 (1,1 - 7,5). CONCLUSIONES: El polen de poaceae es el predominante en la atmósfera de Santander y el que sensibiliza a todos los polínicos. Se demostró una relación del mismo con la rinoconjuntivitis en niños y adultos, y en el asma bronquial en niños. Existe una elevada prevalencia de síntomas de asma en adultos de Santander, con probable implicación de factores de interior. / Objectives: To determine the atmospheric pollen counts in Santander and their effect on this population. METHODS: Hirst volumetric method; analysis of the effect of weather on the pollen counts from 1998 to 2002 by linear association measures; skin tests; association between antihistamine sales and pollen counts; association between daily and weekly pollen counts and weather and pollution variables and Emergency Room admittances caused by rhinitis-conjunctivitis and asthma in children. Survey about asthma symptoms (IUATLD) and indoor risks for asthma. RESULTS: Average annual pollen count was 8,604. Poaceae family predominated (28%). Maximum temperature was the only explanatory variable for pollen counts during its period. All the hay fever patients were sensitized to poaceae. We found a relationship between monthly pollen counts and monthly antihistamine sales (rs= 0.7; p<0.01) and daily and weekly association with admittances for rhinitis-conjunctivitis in children and adults. Admittances to E.R. caused by asthma in children (2396) and in adults (1665) were more frequent from september to december. During the period from may to july the asthma admittances of children were associated with weekly poaceae counts and weekly temperature. Prevalence of asthma symptoms in adults was 15% (9.8 - 20.2). Symptoms were more frequent among those with a pet: 41% vs 14%; OR: 4,2 (1.9-9.2) and among people who had lived in Santander during their first ten years of life: 22% vs 11%; OR: 2.9 (1.1-7.5). CONCLUSIONS: Poaceae pollen is the predominant in the atmosphere of Santander, all the hay fever patients are sensitised to it and there is a relationship between it and rhinitis-conjunctivitis in children and adults and between it and asthma in children. There is a high prevalence of symptoms of asthma in Santander; indoor factors are probably involved.

Made available in DSpace on 2015-07-22T20:49:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-06-29. Added 1 bitstream(s) on 2015-08-11T03:26:12Z : No. of bitstreams: 1 Publico-12851a.pdf: 1993449 bytes, checksum: 6fad4a58fc1b395d08412bb6e3b076ea (MD5). Added 1 bitstream(s) on 2015-08-11T03:26:12Z : No. of bitstreams: 2 Publico-12851a.pdf: 1993449 bytes, checksum: 6fad4a58fc1b395d08412bb6e3b076ea (MD5) Publico-12851b.pdf: 1501009 bytes, checksum: ab8946f01511cdc67f2383a0a9fabaac (MD5). Added 1 bitstream(s) on 2015-08-11T03:26:12Z : No. of bitstreams: 3 Publico-12851a.pdf: 1993449 bytes, checksum: 6fad4a58fc1b395d08412bb6e3b076ea (MD5) Publico-12851b.pdf: 1501009 bytes, checksum: ab8946f01511cdc67f2383a0a9fabaac (MD5) Publico-12851c.pdf: 1843176 bytes, checksum: 32033d7bc48d53d7cb1127e1ae58221f (MD5). Added 1 bitstream(s) on 2015-08-11T03:26:13Z : No. of bitstreams: 4 Publico-12851a.pdf: 1993449 bytes, checksum: 6fad4a58fc1b395d08412bb6e3b076ea (MD5) Publico-12851b.pdf: 1501009 bytes, checksum: ab8946f01511cdc67f2383a0a9fabaac (MD5) Publico-12851c.pdf: 1843176 bytes, checksum: 32033d7bc48d53d7cb1127e1ae58221f (MD5) Publico-12851d.pdf: 1909278 bytes, checksum: 7f3b132a4365c4aeab410fd8f4041429 (MD5) / Objetivos: avaliar os efeitos da fumaça lateral de cigarro (FLC) sobre o controle neural do sistema cardiovascular em ratos normotensos e ratos espontaneamente hipertensos (SHR). Método: ratos Wistar, Wistar-Kyoto (WKY) e SHR foram expostos à FLC durante três semanas, cinco dias por semana, 180 minutos por dia numa concentração de monóxido de carbono entre 100 e 300 ppm. Barorreflexo foi estimulado por uma dose vasodepressora de nitroprussiato de sódio (NPNa, 50Og/kg, i.v.) e uma dose pressora de fenilefrina (PE, 8Og/kg , i.v.). Para avaliar os efeitos da inibição da catalase no quarto ventrículo cerebral (4ºV) sobre as respostas cardiovasculares, foi injetado o inibidor de catalase 3-amino-1,2,4-triazole (ATZ, 0,01Og/100OL). Resultados: nos ratos Wistar expostos à FLC, foi observado que a inibição da catalase causou respostas mais intensas quanto a FC basal e ao pico bradicárdico. A inibição da catalase afetou de maneira mais intensa a FC basal e o pico bradicárdico, nos ratos WKY expostos à FLC. Por outro lado, nos animais SHR a exposição à FLC afetou o pico taquicárdico após inibição central de catalase de maneira mais intensa. Conclusão: a exposição à FLC altera os componentes simpáticos do barorreflexo em ratos WKY e SHR, além de causar respostas cardiovasculares mais intensas perante a inibição de catalase no 4ºV em ratos Wistar e WKY. / Objectives: To evaluate the effects of sidestream cigarette smoke (SSCS) on neural control of cardiovascular system in normotensive and spontaneously hypertensive rats (SHR). Method: Wistar, Wistar-Kyoto rats (WKY) and SHR were exposed to SSCS for three weeks, five days per week, 180 minutes per day at a concentration of carbon monoxide between 100 and 300 ppm. Baroreflex was stimulated with a vasodepressor dose of sodium nitroprusside (NPNa, 50ìg/kg, iv) and with a pressor dose of phenylephrine (PE, 8ìg/kg, iv). In order to evaluate the effects of catalase inhibition into the fourth cerebral ventricle (4th V) on cardiovascular responses, we injected the catalase inhibitor 3-amino-1,2,4-triazole (ATZ, ìg/100ìL 0.01). Results: It was observed in Wistar rats exposed to SSCS that catalase inhibition caused more intense responses on basal HR and bradycardic peak. Central catalase inhibition affected in a higher intensity baseline HR and bradycardic peak WKY rats exposed to SSCS. On the other hand, in SHR SSCS exposure affected the tachycardic peak after central inhibition of catalase in a higher intensuty. Conclusion: Exposure to SSCS alters the sympathetic component of the baroreflex in WKY and SHR and caused more severe cardiovascular responses to catalase inhibition into the 4th V in Wistar and WKY rats. / TEDE / BV UNIFESP: Teses e dissertações

Contexto: Há muito tempo se conhecem os malefícios do tabaco, seja para a saúde individual, coletiva e para o meio ambiente. Por outro lado, a sua produção é também considerada uma cultura das mais rentáveis e gera milhares de empregos e renda, tanto para trabalhadores e empresários, quanto para o Estado, através do recolhimento de valores importantes de impostos. Conhecer relações de exposição ao tabaco e seus possíveis danos à comunidade passa a ser uma ação importante, a fim de se avaliar relações de custo-benefício de tal produção. Objetivos: Georreferenciar os casos de internação hospitalar entre 2010 e 2012 da cidade de Santa Cruz do Sul, uma das maiores produtoras de tabaco do país, para encontrar um padrão de distribuição espacial da moradia destas pessoas e as indústrias do tabaco. Métodos: Foi utilizado um estudo ecológico, com georreferenciamento de casos, através do programa Terraview do Instituto Nacional de Pesquisas Espaciais, de acordo com patologias específicas, através do banco de dados informatizado dos dois hospitais da cidade. Foram gerados mapas representativos, de Kernel, além da utilização de técnicas específicas para detecção de autocorrelações espaciais, como o Índice Global e Local de Moran, Médias Móveis, G e G* e Taxas Bayesianas Empíricas. As unidades de área estudadas foram os bairros da cidade, com informações do censo do Instituto Brasileiro de Geografia e Estatística de 2010. Resultados: Constavam nos registros hospitalares brutos 49.347 registros, sendo 33.377 do Hospital Santa Cruz e 15.970 do Hospital Ana Nery. Após a limpeza dos bancos, através dos critérios de exclusão determinados, foram elegíveis para o georreferenciamento dos casos de internação por neoplasias 285 (0,34%) casos e por doença respiratória 1.013 (2,05%). Em ambos os contextos de causas para internação, não houve uma distribuição espacial que determinasse uma autocorrelação, ou seja, não se demonstrou, no período estudado e para estes dois motivos de internação, que os casos estivessem correlacionados entre si, em se tratando de distribuição no espaço geográfico, tanto da cidade, quanto do entorno das fumageiras. Alguns aspectos relativos a taxas de incidência foram observados entre os anos, com a apresentação de aglomerados (clusters). Conclusões: O uso do delineamento ecológico como forma de se iniciar uma observação entre padrões de eventos dentro de grupos populacionais continua a ser uma ótima ferramenta. Suas fraquezas incluem a alta dependência da qualidade dos dados secundários registrados, que, se não forem cuidadosamente coletados e avaliados, podem diminuir em muito as forças dos achados. Parece não haver um padrão de distribuição espacial das residências de pessoas que foram internadas em um dos hospitais da cidade de Santa Cruz do Sul entre os anos de 2010 e 2012, em relação a neoplasias e doenças respiratórias, tampouco uma correlação com proximidades às indústrias fumageiras. / Background: The dangers of smoking are well known, both for individual, collective health, and for the environment. On the other hand, its production is also considered one of the most profitable crop and generates thousands of jobs and income for both workers and employers, and in the State, through the gathering of important tax values. Meet the relationships of tobacco exposure and the possible damage to the community becomes an important action in order to evaluate the cost-benefit of such production. Objectives: To georeference cases of hospitalization between 2010 and 2012 in the city of Santa Cruz do Sul, one of the largest tobacco producing in Brazil, to find a pattern of spatial of housing distribution of these people and the location of tobacco industries. Methods: An ecological approach with georeferenced cases by the Terraview software from the National Institute for Space Research, under specific conditions, through the computerized database of the two city hospitals. Representative maps were generated, like Kernel’s map, and the use of specific techniques to detect spatial autocorrelation, such as the Moran Global and Local Index, Moving Averages, G and G * and Empirical Bayesian Exchange. The units studied area were the city's neighborhoods with census data from the Brazilian Institute of Geography and Statistics, 2010. Results: There were available 49.347 records in hospital records, being 33.377 from the Santa Cruz Hospital and 15,970 from The Ana Nery Hospital. After cleaning the database, through certain exclusion criteria, 285 neoplasms admissions and 1,103 respiratory diseases were eligible for the georeferencing of hospitalization. In both contexts, there was no one that would determine spatial autocorrelation, ie, was not shown, during the study period and for these two reasons for hospitalization, the cases were correlated with each other, in the case of distribution in geographical space, both for the city, and the surrounding of the tobacco companies. Some aspects of the incidence rates were observed between years, with the presentation of clusters observed. Conclusions: The use of the ecological design as a way to start a note between patterns of events within population groups continues to be a great tool. Their weaknesses include the high dependence of the quality of secondary data, which, if not carefully collected and evaluated, may strongly decrease the strength of findings. There seems not to be a pattern of spatial distribution of the residences of people who were admitted to a hospital in the city of Santa Cruz do Sul between the years 20100 and 2012 in relation to cancer and respiratory diseases, nor a correlation with the nearby tobacco industries.

Contexto: Há muito tempo se conhecem os malefícios do tabaco, seja para a saúde individual, coletiva e para o meio ambiente. Por outro lado, a sua produção é também considerada uma cultura das mais rentáveis e gera milhares de empregos e renda, tanto para trabalhadores e empresários, quanto para o Estado, através do recolhimento de valores importantes de impostos. Conhecer relações de exposição ao tabaco e seus possíveis danos à comunidade passa a ser uma ação importante, a fim de se avaliar relações de custo-benefício de tal produção. Objetivos: Georreferenciar os casos de internação hospitalar entre 2010 e 2012 da cidade de Santa Cruz do Sul, uma das maiores produtoras de tabaco do país, para encontrar um padrão de distribuição espacial da moradia destas pessoas e as indústrias do tabaco. Métodos: Foi utilizado um estudo ecológico, com georreferenciamento de casos, através do programa Terraview do Instituto Nacional de Pesquisas Espaciais, de acordo com patologias específicas, através do banco de dados informatizado dos dois hospitais da cidade. Foram gerados mapas representativos, de Kernel, além da utilização de técnicas específicas para detecção de autocorrelações espaciais, como o Índice Global e Local de Moran, Médias Móveis, G e G* e Taxas Bayesianas Empíricas. As unidades de área estudadas foram os bairros da cidade, com informações do censo do Instituto Brasileiro de Geografia e Estatística de 2010. Resultados: Constavam nos registros hospitalares brutos 49.347 registros, sendo 33.377 do Hospital Santa Cruz e 15.970 do Hospital Ana Nery. Após a limpeza dos bancos, através dos critérios de exclusão determinados, foram elegíveis para o georreferenciamento dos casos de internação por neoplasias 285 (0,34%) casos e por doença respiratória 1.013 (2,05%). Em ambos os contextos de causas para internação, não houve uma distribuição espacial que determinasse uma autocorrelação, ou seja, não se demonstrou, no período estudado e para estes dois motivos de internação, que os casos estivessem correlacionados entre si, em se tratando de distribuição no espaço geográfico, tanto da cidade, quanto do entorno das fumageiras. Alguns aspectos relativos a taxas de incidência foram observados entre os anos, com a apresentação de aglomerados (clusters). Conclusões: O uso do delineamento ecológico como forma de se iniciar uma observação entre padrões de eventos dentro de grupos populacionais continua a ser uma ótima ferramenta. Suas fraquezas incluem a alta dependência da qualidade dos dados secundários registrados, que, se não forem cuidadosamente coletados e avaliados, podem diminuir em muito as forças dos achados. Parece não haver um padrão de distribuição espacial das residências de pessoas que foram internadas em um dos hospitais da cidade de Santa Cruz do Sul entre os anos de 2010 e 2012, em relação a neoplasias e doenças respiratórias, tampouco uma correlação com proximidades às indústrias fumageiras. / Background: The dangers of smoking are well known, both for individual, collective health, and for the environment. On the other hand, its production is also considered one of the most profitable crop and generates thousands of jobs and income for both workers and employers, and in the State, through the gathering of important tax values. Meet the relationships of tobacco exposure and the possible damage to the community becomes an important action in order to evaluate the cost-benefit of such production. Objectives: To georeference cases of hospitalization between 2010 and 2012 in the city of Santa Cruz do Sul, one of the largest tobacco producing in Brazil, to find a pattern of spatial of housing distribution of these people and the location of tobacco industries. Methods: An ecological approach with georeferenced cases by the Terraview software from the National Institute for Space Research, under specific conditions, through the computerized database of the two city hospitals. Representative maps were generated, like Kernel’s map, and the use of specific techniques to detect spatial autocorrelation, such as the Moran Global and Local Index, Moving Averages, G and G * and Empirical Bayesian Exchange. The units studied area were the city's neighborhoods with census data from the Brazilian Institute of Geography and Statistics, 2010. Results: There were available 49.347 records in hospital records, being 33.377 from the Santa Cruz Hospital and 15,970 from The Ana Nery Hospital. After cleaning the database, through certain exclusion criteria, 285 neoplasms admissions and 1,103 respiratory diseases were eligible for the georeferencing of hospitalization. In both contexts, there was no one that would determine spatial autocorrelation, ie, was not shown, during the study period and for these two reasons for hospitalization, the cases were correlated with each other, in the case of distribution in geographical space, both for the city, and the surrounding of the tobacco companies. Some aspects of the incidence rates were observed between years, with the presentation of clusters observed. Conclusions: The use of the ecological design as a way to start a note between patterns of events within population groups continues to be a great tool. Their weaknesses include the high dependence of the quality of secondary data, which, if not carefully collected and evaluated, may strongly decrease the strength of findings. There seems not to be a pattern of spatial distribution of the residences of people who were admitted to a hospital in the city of Santa Cruz do Sul between the years 20100 and 2012 in relation to cancer and respiratory diseases, nor a correlation with the nearby tobacco industries.

Uma das principais externalidades dos transportes na dimensão urbana é a emissão de poluentes locais e a geração de gases de efeito estufa (GEE). O estudo tem por finalidade quantificar as emissões da frota de ônibus urbano de uma cidade brasileira e propor um mecanismo de mitigação de GEE. Para atingir o objetivo, o estudo apresenta os combustíveis e tecnologias disponíveis no Brasil, e através de uma meta-análise identifica as combinações de combustível e tecnologia que proporcionam a maior redução das emissões de CO, HC, NOx, MP e CO2e. Os resultados da análise mostram que algumas das opções de combustível e tecnologia que apresentam melhor desempenho são: B100 associado ao DPF e SCR, GNV associado ao 3WC, B20 associado ao DPF e SCR, e D15 associado ao DPF e SCR. A seguir, as contribuições dos mecanismos de mitigação de GEE para o setor de transportes são analisadas. O impacto do Mecanismo de Desenvolvimento Limpo (MDL) no setor é limitado, e não há muitas perspectivas de atuação. As Ações de Mitigação Nacionalmente Apropriadas (NAMAs), têm potencial para atuar na redução de GEE, e devem proporcionar apoio financeiro oriundo dos fundos climáticos para as ações implantadas nos países em desenvolvimento. Um estudo de caso foi desenvolvido para avaliar a possibilidade de elaboração de uma NAMA para a renovação da frota de ônibus urbano de uma cidade. Os resultados obtidos na meta-análise foram aplicados para avaliar o combustível e tecnologia que proporcionam maior redução das emissões. Os resultados mostram que a renovação da frota tem potencial de desenvolvimento de uma NAMA, visto que reduz emissões de GEE e proporciona co-benefícios; contudo, deve-se estabelecer um sistema de MRV (Monitorar, Reportar, Verificar) capaz de quantificar as emissões na mitigação. / One of the main externalities from urban transportation is the emission of local pollutants and greenhouse gases (GHG). The study aims to quantify the emissions from the urban bus fleet of a Brazilian city and propose a GHG mitigation mechanism. First, the study presents the fuels and technologies available in Brazil, and through a meta-analysis identifies combinations of fuel and technology that provide the greatest reduction in emissions of CO, HC, NOx, PM and CO2e. Results show the fuel and technology that perform best are: B100 associated with DPF and SCR, CNG associated with 3WC, B20 associated with DPF and SCR, and D15 associated with DPF and SCR. The contribution of GHG mitigation mechanisms for the transport sector was analyzed. The impact of the Clean Development Mechanism (CDM) in the sector is limited, and there are not many perspectives for the future. The Nationally Appropriate Mitigation Actions, named NAMAs, have the potential to act in reducing GHG in transport sector, and should provide financial cooperation through climate funds for implementation of actions in developing countries. A case study was developed to evaluate the possibility of developing a NAMA for the renewal of the fleet of urban buses in a Brazilian city. The results obtained in the meta-analysis were applied to evaluate which fuel and technology provide greater reductions in emission. The results show that the renewal of the fleet has the potential for developing a NAMA, since it reduces greenhouse gas emissions and provide co-benefits; however it requires a serious MRV (Monitor, Report, Verify) capable of quantifying the mitigation of emissions.

Contexto: Há muito tempo se conhecem os malefícios do tabaco, seja para a saúde individual, coletiva e para o meio ambiente. Por outro lado, a sua produção é também considerada uma cultura das mais rentáveis e gera milhares de empregos e renda, tanto para trabalhadores e empresários, quanto para o Estado, através do recolhimento de valores importantes de impostos. Conhecer relações de exposição ao tabaco e seus possíveis danos à comunidade passa a ser uma ação importante, a fim de se avaliar relações de custo-benefício de tal produção. Objetivos: Georreferenciar os casos de internação hospitalar entre 2010 e 2012 da cidade de Santa Cruz do Sul, uma das maiores produtoras de tabaco do país, para encontrar um padrão de distribuição espacial da moradia destas pessoas e as indústrias do tabaco. Métodos: Foi utilizado um estudo ecológico, com georreferenciamento de casos, através do programa Terraview do Instituto Nacional de Pesquisas Espaciais, de acordo com patologias específicas, através do banco de dados informatizado dos dois hospitais da cidade. Foram gerados mapas representativos, de Kernel, além da utilização de técnicas específicas para detecção de autocorrelações espaciais, como o Índice Global e Local de Moran, Médias Móveis, G e G* e Taxas Bayesianas Empíricas. As unidades de área estudadas foram os bairros da cidade, com informações do censo do Instituto Brasileiro de Geografia e Estatística de 2010. Resultados: Constavam nos registros hospitalares brutos 49.347 registros, sendo 33.377 do Hospital Santa Cruz e 15.970 do Hospital Ana Nery. Após a limpeza dos bancos, através dos critérios de exclusão determinados, foram elegíveis para o georreferenciamento dos casos de internação por neoplasias 285 (0,34%) casos e por doença respiratória 1.013 (2,05%). Em ambos os contextos de causas para internação, não houve uma distribuição espacial que determinasse uma autocorrelação, ou seja, não se demonstrou, no período estudado e para estes dois motivos de internação, que os casos estivessem correlacionados entre si, em se tratando de distribuição no espaço geográfico, tanto da cidade, quanto do entorno das fumageiras. Alguns aspectos relativos a taxas de incidência foram observados entre os anos, com a apresentação de aglomerados (clusters). Conclusões: O uso do delineamento ecológico como forma de se iniciar uma observação entre padrões de eventos dentro de grupos populacionais continua a ser uma ótima ferramenta. Suas fraquezas incluem a alta dependência da qualidade dos dados secundários registrados, que, se não forem cuidadosamente coletados e avaliados, podem diminuir em muito as forças dos achados. Parece não haver um padrão de distribuição espacial das residências de pessoas que foram internadas em um dos hospitais da cidade de Santa Cruz do Sul entre os anos de 2010 e 2012, em relação a neoplasias e doenças respiratórias, tampouco uma correlação com proximidades às indústrias fumageiras. / Background: The dangers of smoking are well known, both for individual, collective health, and for the environment. On the other hand, its production is also considered one of the most profitable crop and generates thousands of jobs and income for both workers and employers, and in the State, through the gathering of important tax values. Meet the relationships of tobacco exposure and the possible damage to the community becomes an important action in order to evaluate the cost-benefit of such production. Objectives: To georeference cases of hospitalization between 2010 and 2012 in the city of Santa Cruz do Sul, one of the largest tobacco producing in Brazil, to find a pattern of spatial of housing distribution of these people and the location of tobacco industries. Methods: An ecological approach with georeferenced cases by the Terraview software from the National Institute for Space Research, under specific conditions, through the computerized database of the two city hospitals. Representative maps were generated, like Kernel’s map, and the use of specific techniques to detect spatial autocorrelation, such as the Moran Global and Local Index, Moving Averages, G and G * and Empirical Bayesian Exchange. The units studied area were the city's neighborhoods with census data from the Brazilian Institute of Geography and Statistics, 2010. Results: There were available 49.347 records in hospital records, being 33.377 from the Santa Cruz Hospital and 15,970 from The Ana Nery Hospital. After cleaning the database, through certain exclusion criteria, 285 neoplasms admissions and 1,103 respiratory diseases were eligible for the georeferencing of hospitalization. In both contexts, there was no one that would determine spatial autocorrelation, ie, was not shown, during the study period and for these two reasons for hospitalization, the cases were correlated with each other, in the case of distribution in geographical space, both for the city, and the surrounding of the tobacco companies. Some aspects of the incidence rates were observed between years, with the presentation of clusters observed. Conclusions: The use of the ecological design as a way to start a note between patterns of events within population groups continues to be a great tool. Their weaknesses include the high dependence of the quality of secondary data, which, if not carefully collected and evaluated, may strongly decrease the strength of findings. There seems not to be a pattern of spatial distribution of the residences of people who were admitted to a hospital in the city of Santa Cruz do Sul between the years 20100 and 2012 in relation to cancer and respiratory diseases, nor a correlation with the nearby tobacco industries.

Estrogens, alkylphenols and bisphenol-A, enter the environment through waste water systems and waste disposal of manufactured products e.g. detergents, paints, polycarbonates and flameretardants. These analytes disrupt the endocrine function of living organisms affecting their reproductive health and those of future generations. Gas phase low molecular- mass aldehydes and amines are typically eye, nose, and throat irritants. Formaldehyde is classified as a probable human carcinogen. Given their negative impact on human health it is urgent to monitor pollutants at extremely low levels in both air and water. The aqueous pollutants are often concentrated using solid phase extraction cartridges or liquid-liquid extraction followed by derivatization. Methods that can most effectively and selectively pre-concentrate aldehydes and amines involve in situ derivatization. Unfortunately, the derivatizing reagents as well as their associated solvents or adsorbents, are responsible for problems encountered with these methods. Polydimethylsiloxane (PDMS) has emerged as the ideal concentration and reaction medium for trace analysis. However the expensive commercial devices such as SPME and SBSE both require the samples to be returned to the laboratory for concentration. Due to the open tubular nature of the PDMS multichannel trap (MCT), developed in our laboratory, it is ideally suited for on-site and online sampling. The MCTs have a high analyte capacity owing to the large volume of PDMS available for concentration. The derivatization reaction can be performed in situ providing a “onepot concentration and reaction device”. This allows for reduced risk of contamination of / or losses of the sample and a sampling method that can cater for both air and water samples. To demonstrate the versatility of the PDMS MCT, two approaches for concentration in PDMS were investigated in this study, namely, 1) the on-line concentration and in situ derivatization of volatile polar analytes from air followed by REMPI-TOFMS detection, and 2) the concentration of phenolic lipophilic analytes from water requiring derivatization prior to analysis by GC/MS. 1) Analyte and derivatizing reagent were simultaneously introduced into the PDMS trap using a ypress- fit connector. The reaction occurs in situ followed by thermal desorption using a thermal modulator array alone or in conjunction with a thermal desorption unit. The aldehydes and amine derivatives were successfully detected by the REMPI-TOFMS. Reaction efficiencies were determined at room temperature without catalysts. Formaldehyde yielded a low reaction/concentration efficiency of 41 % with phenylhydrazine in PDMS, while acetaldehyde, acrolein and crotonal displayed much improved values of 92, 61 and 74 % respectively. Both propylamine and butylamine yielded 28 % reaction/concentration efficiency with benzaldehyde in the PDMS matrix. Detection limits obtained with this technique were significantly lower than the permissible exposure limits set by the Occupational Safety and Health Administration. It should be noted that the detection limits were not determined by actual measurement but by extrapolation from a larger signal. 2) Aqueous analytes were concentrated in the PDMS MCT using a gravity flow rate of ~50 ìl/min. The trap was dried and 5 ìl derivatizing reagent added. At room temperature and without the presence of a catalyst, the reaction of alkylphenols with trifluoroacetic acid anhydride in the PDMS matrix was 100% complete after 5 minutes. Bisphenol-A reacted less than 50 % to completion during this period, but the amount of derivative formed remained constant. This study revealed that extraction efficiencies of the alkylphenols and bisphenol-A off the PDMS trap have poor batch-tobatch repeatability indicating that the PDMS matrix was not homogenous. For two different PDMS batches: tert-octylphenol displayed an extraction efficiency of 70 and 79%, nonylphenol displayed 84 and 43% while Bisphenol-A displayed 10 and 26% respectively. The thermally desorbed derivatives were analysed by GC/MS. Despite background contamination in the desorption unit, detection limits were at the ppt level. Detection limits were not determined by actual measurement but by extrapolation from a larger signal. / Thesis (PhD)--University of Pretoria, 2009. / Chemistry / unrestricted

Uma das principais externalidades dos transportes na dimensão urbana é a emissão de poluentes locais e a geração de gases de efeito estufa (GEE). O estudo tem por finalidade quantificar as emissões da frota de ônibus urbano de uma cidade brasileira e propor um mecanismo de mitigação de GEE. Para atingir o objetivo, o estudo apresenta os combustíveis e tecnologias disponíveis no Brasil, e através de uma meta-análise identifica as combinações de combustível e tecnologia que proporcionam a maior redução das emissões de CO, HC, NOx, MP e CO2e. Os resultados da análise mostram que algumas das opções de combustível e tecnologia que apresentam melhor desempenho são: B100 associado ao DPF e SCR, GNV associado ao 3WC, B20 associado ao DPF e SCR, e D15 associado ao DPF e SCR. A seguir, as contribuições dos mecanismos de mitigação de GEE para o setor de transportes são analisadas. O impacto do Mecanismo de Desenvolvimento Limpo (MDL) no setor é limitado, e não há muitas perspectivas de atuação. As Ações de Mitigação Nacionalmente Apropriadas (NAMAs), têm potencial para atuar na redução de GEE, e devem proporcionar apoio financeiro oriundo dos fundos climáticos para as ações implantadas nos países em desenvolvimento. Um estudo de caso foi desenvolvido para avaliar a possibilidade de elaboração de uma NAMA para a renovação da frota de ônibus urbano de uma cidade. Os resultados obtidos na meta-análise foram aplicados para avaliar o combustível e tecnologia que proporcionam maior redução das emissões. Os resultados mostram que a renovação da frota tem potencial de desenvolvimento de uma NAMA, visto que reduz emissões de GEE e proporciona co-benefícios; contudo, deve-se estabelecer um sistema de MRV (Monitorar, Reportar, Verificar) capaz de quantificar as emissões na mitigação. / One of the main externalities from urban transportation is the emission of local pollutants and greenhouse gases (GHG). The study aims to quantify the emissions from the urban bus fleet of a Brazilian city and propose a GHG mitigation mechanism. First, the study presents the fuels and technologies available in Brazil, and through a meta-analysis identifies combinations of fuel and technology that provide the greatest reduction in emissions of CO, HC, NOx, PM and CO2e. Results show the fuel and technology that perform best are: B100 associated with DPF and SCR, CNG associated with 3WC, B20 associated with DPF and SCR, and D15 associated with DPF and SCR. The contribution of GHG mitigation mechanisms for the transport sector was analyzed. The impact of the Clean Development Mechanism (CDM) in the sector is limited, and there are not many perspectives for the future. The Nationally Appropriate Mitigation Actions, named NAMAs, have the potential to act in reducing GHG in transport sector, and should provide financial cooperation through climate funds for implementation of actions in developing countries. A case study was developed to evaluate the possibility of developing a NAMA for the renewal of the fleet of urban buses in a Brazilian city. The results obtained in the meta-analysis were applied to evaluate which fuel and technology provide greater reductions in emission. The results show that the renewal of the fleet has the potential for developing a NAMA, since it reduces greenhouse gas emissions and provide co-benefits; however it requires a serious MRV (Monitor, Report, Verify) capable of quantifying the mitigation of emissions.

Die gesundheitsschädliche Wirkung unreiner Luft ist Gegenstand unzähliger Studien und wurde bereits hinreichend nachgewiesen. Der Straßenverkehr ist dabei eine der wesentlichsten Schadstoffquellen, denen der Mensch im Alltag ausgesetzt ist. Ziel dieser Arbeit ist es, die Schadstoffbelastung von Nutzern des Straßenverkehrs vertiefend abzubilden. Im Rahmen eines Literaturreviews werden insgesamt 50 wissenschaftliche Studien analysiert. Obwohl sich viele Studien mit dem Vergleich der Verkehrsmittel bezüglich der Immissionsexposition auseinandersetzen, widersprechen sich ihre Ergebnisse je nach Schadstoff regelmäßig hinsichtlich der Reihenfolge der Verkehrsmittel oder auch grundsätzlich bezüglich der Signifikanz der Verkehrsmittelwahl. Ursache dafür sind die zahlreichen Einflussfaktoren, die sich von Arbeit zu Arbeit unterscheiden und eine Vergleichbarkeit der Messergebnisse stark erschweren. Trotz einer steigenden Anzahl an Studien zum Thema mangelt es den Messmethoden an einem strengen Qualitätsstandard sowie einer ausführlichen Dokumentation der Messbedingungen. Eine Verallgemeinerung und Vergleichbarkeit der Forschungsergebnisse untereinander ist damit bislang nicht gewährleistet. Die Betrachtung der Luftqualität bildet die wissenschaftliche Grundlage, um Grenzwertüberschreitungen aufzuspüren, Gegenmaßnahmen zu erarbeiten und diese auf ihre Wirksamkeit zu kontrollieren. Die Werte stationärer Messeinrichtungen geben dabei ein nur unzureichend genaues Bild über die Immissionen, denen die Nutzer des Straßenverkehrs ausgesetzt sind. Um ein realistischeres Bild über die Immissionsbelastung von Verkehrsteilnehmern zu gewinnen, wird mittels eines mobilen Messgeräts die PM10-Belastung für Radfahrer in Teilen des Dresdner Straßennetzes bestimmt. Dabei wird deutlich, dass die gemessene Schadstoffkonzentration sowohl räumlich innerhalb einer Messstrecke als auch zeitlich im Laufe des Tages variiert. Um den weitestgehend emissionsarmen Rad- und Fußverkehr weiter zu fördern und auszubauen, ist es nötig, die Schadstoffbelastung dieser Verkehrsteilnehmer noch besser zu verstehen und quantifizieren zu können. Nur dann sind Verkehrsplaner und Entscheidungsträger in der Lage, eine Infrastruktur zu schaffen, die ihre Nutzer so wenig wie möglich gesundheitlich beeinträchtigt.

Hintergrund: Nicht nur in Deutschland, sondern auch weltweit sind Herz-Kreislauf-Erkrankungen die häufigste Todesursache. Auf Platz vier folgen psychische und Verhaltensstörungen (Statistisches Bundesamt, 2020). Verschiedene Studien zeigen, dass Straßenverkehrslärm das Risiko erhöht, an Herz-Kreislauf-Erkrankungen oder an einer Depression zu erkranken (Seidler et al., 2017; WHO, 2018). Zunehmend betrachten Studien die Auswirkungen von Straßenverkehrslärm und Luftschadstoffen auf die Gesundheit unter Berücksichtigung der jeweiligen anderen Exposition (Sørensen et al., 2014; Zijlema et al., 2016). Systematische Übersichtsarbeiten, die den Einfluss der Berücksichtigung des potenziellen Confoundings durch Luftschadstoffe auf Krankheitsrisiken durch Straßenverkehrslärm untersuchen, gibt es bisher kaum. Lediglich die systematischen Reviews von Tétreault et al. (2013) und Vienneau et al. (2015) untersuchten die eventuelle Verzerrung der Risikoschätzer durch die jeweilige andere Exposition. Aufgrund der Zunahme der Studien zu dieser Fragestellung seit 2013 und den aktuellen Leitlinien der WHO für Umgebungslärm, die Lärmbelastung zu den wichtigsten umweltbedingten Gefahren für die Gesundheit zählen, soll mit Methoden der evidenzbasierten Medizin die Frage nach den „isolierten“ gesundheitlichen Auswirkungen von Straßenverkehrslärm auf Herz-Kreislauf-Erkrankungen und Depressionen untersucht werden. Forschungsanliegen: Die verkehrslärmbedingten Risiken für Herz-Kreislauf-Erkrankungen und depressive Erkrankungen sollen unter der Berücksichtigung des Einflusses von Luftschadstoffen mit einem systematischen Review mit Metaanalyse untersucht werden. Methode: Zunächst wurde mittels eines Rapid Reviews der aktuelle Forschungsstand zum Zusammenhang zwischen Straßenverkehrslärm und Herzkreislauferkrankungen sowie Depressionen zusammengefasst. Die Literaturrecherche wurde in der Datenbank PubMed durchgeführt, und die AMSTAR 2 Checkliste wurde zur Qualitätsbewertung der systematischen Reviews genutzt. Anschließend wurde ein originäres systematisches Review durchgeführt, eng angelehnt an die Arbeitsschritte, die vom Cochrane-Netzwerk entwickelt wurden. Demnach wurde nach dem Erstellen eines Studienprotokolls, dem Festlegen der Ein- und Ausschlusskriterien und der Entwicklung eines Suchstrings eine systematische Literaturrecherche in den Datenbanken PubMed, EMBASE und PsycInfo durchgeführt. Es folgte die Titel-/Abstract-Sichtung sowie eine anschließende Volltextsichtung durch zwei Reviewerinnen unabhängig voneinander. Zusätzlich wurde das „Risk of Bias“ (RoB) der eingeschlossenen Studien bewertet. Anschließend wurde geprüft, ob eine Metaanalyse durchgeführt werden kann. Zur Ermittlung der Verzerrung des Risikoschätzers für Straßenverkehrslärm durch Luftschadstoffe wurde mit dem Change-in-Estimate-Verfahren (CIE-Verfahren) der adjustierte Effektschätzer (mit Adjustierung für Luftschadstoffe) mit dem nicht für Luftschadstoffe adjustierten straßenlärmbezogenen Effektschätzer verglichen. Es wurden zur Berechnung des CIE-Wertes drei Hauptanalysen durchgeführt, bei denen drei unterschiedliche Rechenwege (1. nach Tétreault et al. (2013), 2. nach Floud et al. (2013) und 3. unter Anwendung der selbst abgeleiteten Methode der Exzess-Risiko-Veränderung) genutzt wurden. Weiterhin wurden zwei Sensitivitätsanalysen durchgeführt, die die Stabilität des CIE-Wertes gegenüber Veränderungen der Expositionsmetriken untersuchen sollten. Zur besseren Vergleichbarkeit wurden die Risikoschätzer der einbezogenen Primärstudien auf einen kontinuierlichen Straßenverkehrslärmanstieg pro 10 dB umgerechnet und je nach Outcome-Definition einer Haupt- und vier Nebenanalysen unterzogen. In der Hauptanalyse wurden die Risikoschätzer der Inzidenz- und Prävalenzstudien zu MI, KHK und Schlaganfall zusammengefasst. Abschließend wurden die GRADE-Kriterien im Sinne einer Bewertung der Vertrauenswürdigkeit der Evidenz verwendet (Guyatt et al., 2011). Ergebnisse: Im Zuge des Rapid Reviews wurden 14 systematische Reviews eingeschlossen. In dieser Arbeit konnten die Ergebnisse von drei qualitativ hochwertigen Reviews zur Einschätzung der Erkenntnislage zu den Auswirkungen von Straßenverkehrslärm auf Herz-Kreislauf-Erkrankungen genutzt werden. Auf Grundlage der qualitativ hochwertigen Reviews zeigte sich ein relevanter Einfluss von Straßenverkehrslärm auf Herzkreislauferkrankungen (RR: 1,08 pro 10 dB (LDEN); 95 % Konfidenzintervall (KI): 1,01–1,15 (Van Kempen et al., 2018)) und nur eine geringe Risikoerhöhung für eine Hypertonie (Dzhambov & Dimitrova, 2017, 2018). Zwei systematische Reviews betrachteten die Auswirkungen von Straßenverkehrslärm auf Depression und konnten keinen wesentlichen Einfluss von Straßenverkehrslärm aufzeigen. In das systematische Review konnten 22 Primärstudien eingeschlossen werden. Von diesen konnten sechs Inzidenzstudien, drei Prävalenzstudien und vier Mortalitätsstudien in die Metaanalyse einbezogen werden. Drei dieser Inzidenzstudien erhielten im Zuge der RoB-Bewertung eine hohe Qualitätsbewertung. Die Hauptanalyse zeigte für die Diagnose eines MI, einer KHK und eines Schlaganfalls eine statistisch signifikante Risikoerhöhung um 3 % pro 10 dB Erhöhung des Straßenverkehrslärmpegels nach Adjustierung für Luftschadstoffe. Die Ergebnisse zeigten, dass je nach verwendeter Methode die CIE-Werte stark variierten. Die von Tétreault et al. (2013) angewandte Methode sollte zukünftig nicht mehr verwendet werden, da sie bei einem linearen Risikoverlauf in Abhängigkeit von der Wahl des Nenners der Steigung (z.B. pro 10 dB, pro 30 dB) unterschiedliche CIE-Werte liefert. Bei allen Metaanalysen der Inzidenz- und Prävalenzstudien waren die für Luftschadstoff adjustierten gepoolten Risikoschätzer etwas größer als die gepoolten unadjustierten Risikoschätzer, lediglich bei den gepoolten Risikoschätzern der Mortalitätsstudien waren die adjustierten Risikoschätzer etwas kleiner als die nicht adjustierten. In keiner Analyse konnte ein statistisch signifikanter Unterschied zwischen adjustierten und nicht adjustierten Risikoschätzern gefunden werden. Es fand-sich somit kein Anhalt für eine Überschätzung der Risiken von Straßenverkehrslärm durch einen konkurrierenden Effekt von Luftschadstoffen. Für Depressionen erlaubte die Studienlage keine Aussage dazu, ob die straßenverkehrslärmbezogenen Risiken bei fehlender Berücksichtigung eines potenziellen Confoundings durch Luftschadstoffe überschätzt werden. Schlussfolgerung: Zusammenfassend konnte mit Methoden der evidenzbasierten Medizin (Meta-Review in Form eines Rapid Reviews, systematisches Review mit Metaanalyse) ein Anstieg des Risikos für spezifische Herz-Kreislauf-Erkrankungen (MI, KHK und Schlaganfall) um 3 % pro 10 dB Straßenverkehrslärm gefunden werden. Der vorgenannte Risikoschätzer berücksichtigt Luftschadstoffe als potenzielle Confounder. Eine fehlende Adjustierung für Luftschadstoffe führt in der Tendenz zu einem etwas geringeren straßenlärmbezogenen Risikoschätzer; der Unterschied zwischen adjustiertem und nicht adjustiertem Risikoschätzer ist allerdings statistisch nicht signifikant. Aus den Ergebnissen der vorliegenden Arbeit kann geschlussfolgert werden, dass straßenverkehrslärmbezogene Risiken nicht zur Überschätzung tendieren, wenn nicht für Luftschadstoffe adjustiert wird. Studien und Reviews der letzten Jahre haben gezeigt, dass Menschen mit einem niedrigeren sozioökonomischen Status die am stärksten exponierte Gruppe bezüglich Umweltfaktoren darstellen (Hoffimann et al., 2017; Seidler et al., 2019; WHO, 2019a). Maßnahmen zur Reduktion des Straßenverkehrslärms können das Risiko für Herzkreislauf-Erkrankungen und auch für Depressionen verringern; die Planung solcher Maßnahmen sollte den Aspekt der Umweltgerechtigkeit berücksichtigen.:Abbildungsverzeichnis Tabellenverzeichnis Formelverzeichnis Abkürzungsverzeichnis 1 Einleitung 1.1 Hintergrund 1.1.1 Betrachtete Krankheitsbilder 1.1.1.1 Herz-Kreislauf-Erkrankungen 1.1.1.2 Depression 1.1.2 Soziale Determinanten von Gesundheit 1.1.3 (Mögliche) pathophysiologische Auswirkungen der Straßenverkehrslärmexposition 1.1.4 (Mögliche) pathophysiologische Auswirkungen der Luftschadstoffe 1.1.5 Lärm 1.1.5.1 Straßenverkehrslärm 1.1.5.2 Maße und Erhebung 1.1.6 Luftschadstoffe 1.1.6.1 Definition 1.1.6.2 Maße und Erhebung 1.1.7 Potenzieller konkurrierender Effekt von Luftschadstoffen auf die Auswirkungen von Straßenverkehrslärm auf Herz-Kreislauf-Erkrankung und Depression 1.1.8 Konkurrierende Faktoren bzw. Confounding 1.2 Intention und Bedeutung des Reviews 1.3 Definition des Forschungsanliegens 2 Methoden 2.1 Rapid Review 2.1.1 Grundlegendes 2.1.2 Studienprotokoll 2.1.3 Formulierung der Forschungsfrage 2.1.4 Definition der Ein- und Ausschlusskriterien 2.1.4.1 Population 2.1.4.2 Exposition 2.1.4.3 Outcome 2.1.4.4 Design 2.1.5 Sprache und Zeitraum 2.1.6 Literaturrecherche und Erstellen eines Suchstrings 2.1.7 Sichtung und Auswahl der systematischen Reviews 2.1.8 Datenextraktion der Systematischen Reviews 2.1.9 AMSTAR 2–Instrument 2.2 Systematisches Review 2.2.1 Grundlegendes 2.2.2 Studienprotokoll 2.2.3 Formulierung der Forschungsfrage 2.2.4 Definition der Ein- und Ausschlusskriterien 2.2.4.1 Population 2.2.4.2 Exposition 2.2.4.3 Outcome 2.2.4.4 Design 2.2.5 Sprache und Zeitraum 2.2.6 Entwicklung eines Suchstrings 2.2.7 Elektronische Datenbanken 2.2.8 Ergänzende Suchstrategie 2.2.9 Studienselektion 2.2.10 Datenextraktion 2.2.11 Bewertung der Studienqualität 2.2.12 Statistische Auswertung 2.2.12.1 Betrachtung des möglichen konkurrierenden Effektes und Change-in-Estimate 2.2.12.2 Berechnung des CIE 2.2.12.3 Metaanalyse 2.2.13 Bewertung der Vertrauenswürdigkeit der Evidenz 3 Ergebnisse 3.1 Rapid Review 3.1.1 Literaturrecherche 3.1.2 Flussdiagramm 3.1.3 Charakteristika der eingeschlossenen Reviews und AMSTAR 2-Bewertung 3.1.4 Effekte der Exposition auf das Outcome 3.1.5 Primärstudien (NORAH-Studie zu Krankheitsrisiken) 3.1.6 Zusammenfassung der Ergebnisse mit Bezug zur Forschungsfrage des Rapid Reviews 3.2 Systematisches Review 3.2.1 Ergebnisse der Literaturrecherche 3.2.1.1 Elektronische Datenbanksuche 3.2.1.2 Flussdiagramm 3.2.1.3 Ergänzende Suchstrategie 3.2.1.4 Kontaktieren der Autor*innen 3.2.2 Verlauf der Studienselektion 3.2.3 Allgemeine Studien Merkmale 3.2.3.1 Publikationsjahre 3.2.3.2 Länder und Stichprobengrößen 3.2.3.3 Einzelstudien 3.2.4 Qualitätsbewertung der Studien – Risk of Bias 3.2.5 Effekte der Exposition auf das Outcome 3.2.5.1 Inzidenzenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und kardiovaskulären Erkrankungen 3.2.5.2 Inzidenzenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und Myokardinfarkt 3.2.5.3 Inzidenzenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und Schlaganfall 3.2.5.4 Prävalenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und Herz-Kreislauf-Erkrankungen 3.2.5.5 Mortalitätsstudien zu den Auswirkungen von Straßenverkehrslärm auf Herz-Kreislauf-Erkrankungen 3.2.5.6 Inzidenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und Depression 3.2.6 Metaanalyse 3.2.6.1 Zusammenfassung der Ergebnisse 3.2.6.2 Change-in-Estimate-Berechnung 3.2.7 Publikationsbias 3.2.8 Bewertung der Vertrauenswürdigkeit der Evidenz 3.2.9 Beantwortung der Forschungsfragen 3.2.9.1 Gibt es einen Zusammenhang zwischen Straßenverkehrslärm und Herzkreislauf-Erkrankung sowie Depression, wenn gleichzeitig die Exposition gegenüber Luftschadstoffen (z.B. NOX; PM2.5; PM10) berücksichtigt wird? 3.2.9.2 Was ist die Expositions-Risiko-Beziehung von Straßenverkehrslärm und Herz-Kreislauf-Erkrankung und Depression, wenn die Exposition gegenüber Luftschadstoffen berücksichtigt wird? 4 Diskussion 4.1 Rapid Review 4.1.1 Interpretation 4.1.2 Stärken und Limitationen 4.2 Systematisches Review 4.2.1 Ergebnisdarstellung vor dem Hintergrund der aktuellen Literatur 4.2.2 Interpretation der Ergebnisse 4.2.2.1 Zusammenhang zwischen Straßenverkehrslärm und Herz-Kreislauf-Erkrankungen unter der Berücksichtigung von Luftschadstoffen 4.2.3 Stärken und Limitationen 4.2.3.1 Stärken 4.2.3.2 Mögliche Fehlerquellen und Limitationen 4.2.4 Publikationsbias 4.2.5 Bewertung der Vertrauenswürdigkeit der Evidenz 4.3 Schlussfolgerung und Ausblick Zusammenfassung Summary Literaturverzeichnis Anhang Danksagung Anlagen